Wednesday, December 20, 2017

What did Donald Trump do today?

He took credit for an increase in the number of Americans without health insurance.

At a White House ceremony today marking the passage of a tax bill, Trump praised himself for his political strategy of not calling attention to one of the bill's provisions: effectively ending the individual mandate part of the Affordable Care Act. Acknowledging that Obamacare, as it is sometimes known, had been too popular to safely repeal directly, Trump congratulated himself on his self-restraint for not calling the public's attention to the tax bill's impact:

We didn't want to bring it up. I told people specifically "be quiet with the fake news media because I don't want them talking too much about it." Because I didn't know how people would [react].

Whether the tax bill "effectively repeals" Obamacare, as Trump claimed, is a matter of perspective. All of the ACA's popular provisions will remain in force: insurers will be forbidden from turning people away because of pre-existing conditions, the state and federal exchanges will continue to operate, and Medicaid expansion will remain in the states that have adopted it. The cost to the federal government will not go down--in fact, because of rising premiums as a result of declining enrollment, it will cost the government more even as it reduces the government's revenue.

But the absence of the mandate, which creates a viable market for private health insurance, will certainly cause the number of uninsured Americans to rise--by about 13,000,000, according to the Congressional Budget Office. And since the people most likely to lose their coverage are the healthiest, that means that health insurance will definitely be more expensive for everyone else, according to insurance industry experts.